17 Les bêtabloquants après un infarctus SIGN GUIDELINES 5.2 Beta-blockers Early studies consisted of the use of oral beta-blockers initiated 5-28 days after myocardial infarction. The Norwegian Multicentre Study using timolol resulted in a 39% reduction in overall mortality and a 28% reduction in re-infarction at 33 months, 69 with an absolute risk reduction of 4.6%. Similar results were reported in the beta-blocker heart attack trial (B-HAT) using propranolol, in which a 28% reduction in mortality was found in the propranolol group, with an absolute risk reduction of 2.6%. Rates of mortality from cardiovascular cause and sudden death were lower in the propranolol group. 70 Evidence level Ib A meta-analysis of 25 randomised trials involving over 20,000 patients on long term beta-blocker therapy after myocardial infarction showed a 23% reduction in total mortality (NNT = 51) and a 32% reduction in sudden death. 71 Evidence level Ia Beta-blocker therapy should be considered for patients following myocardial infarction unless there are contraindications. 69 Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981; 304: A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982; 247: Held PH, Yusuf S. Effect of (-blockers and calcium channel blockers in acute myocardial infarction. Eur Heart J 1993; 14 (suppl F):

27 GPAQ 2005 Report on questions relating to individual doctors Dr Dobler Question 11. Thinking of the doctor you saw today, how do you rate the following: 11a. How thoroughly your doctor asks about your symptoms and how you are feeling? Individual Doctor % Good / Excellent rating Practice Overall average 73% (11/15) 90% 91% 11b. How well your usual doctor listens to what you say? 80% (12/15) 92% 94% 11c. How well your doctor puts you at ease during your 79% (11/14) 93% 93% physical examination? 11d. How well your doctor explains your health problems or 73% (11/15) 90% 92% any treatment that you need? 11e. How well your doctor involves you in decisions about 73% (11/15) 88% 91% your care? 11f. Your doctor s patience with your questions or worries? 73% (11/15) 92% 93% 11g. Your doctor s care and concern for you? 80% (12/15) 92% 93% 11h. The amount of time your doctor spends with you? 73% (11/15) 89% 87% Never or almost never 12. How often do you leave with unanswered questions after seeing the doctor you saw today? 60% (9/15) 75% 78% Much more than before the visit 13. After a visit to the doctor you saw today, would you say that you generally feel: 55% (6/11) 52% 55% 13a. able to understand your problems or illness 13b. able to cope with your problems or illness? 36% (4/11) 47% 51% 13c. able to keep yourself healthy? 30% (3/10) 45% 47%

32 Ia Ib Evidence obtained from meta-analysis of randomised controlled trials. Evidence obtained from at least one randomised controlled trial. IIa Evidence obtained from at least one well-designed controlled study without randomisation. IIb I I I Evidence obtained from at least one other type of well-designed quasi-experimental study. Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies. I V Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Grades of Recommendations Requires at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation. (Evidence levels Ia, Ib) Requires the availability of well conducted clinical studies but no randomised clinical trials on the topic of recommendation. (Evidence levels IIa, IIb, III) Requires evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. Indicates an absence of directly applicable clinical studies of good quality. (Evidence level IV) Recommended best practice based on the clinical experience of the guideline development group

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